Some links and readings posted by Gary B. Rollman, Emeritus Professor of Psychology, University of Western Ontario

Wednesday, February 24, 2010

“We’ve Got Issues,” by Judith Warner - Review - NYTimes.com

Picture a cupped hand. A capsule and a pill lie in the palm. The hand is extended toward a small child. The caption reads, "Take your vitamins."

It's better than a Rorschach test, that image: most people will erupt with a passionate visceral reaction, especially if they deduce that the proffered medications are not vitamins at all, but strong psychoactive drugs like Ritalin and Prozac.

For some, the picture symbolizes the best kind of parenting, proactive and nurturing. For others, it is an evocative summary of everything that is wrong with our culture, as pushy parents blithely dose hapless children with unnecessary medication in the name of conformity and achievement.

The journalist Judith Warner was a die-hard member of the second camp, and wanted to spread the word. Six years ago, she happily landed a book contract to explore and document the overmedication of American youth.

Readers of Domestic Disturbances, the online column Ms. Warner wrote for The New York Times until December, will be familiar with what happened next. She sallied forth to interview all the pushy parents, irresponsible doctors and overmedicated children she could find — and lo, she could barely find any. After several years of dead ends, missed deadlines and worried soul-searching, she was forced to reconsider her premise and start all over again.

"We've Got Issues" is the product of that unusual cycle. Journalists who cobble together enough anecdotes to support a preset agenda are all too common, and presumably Ms. Warner could have managed to do just that. Instead, she actually let her research guide her thoughts: it whirled her perspective a full 180 degrees and, as she would be the first to affirm, lifted the scales from her eyes.

"A couple of simple truths have become clear," she writes with the passion of a new convert. "That the suffering of children with mental health issues (and their parents) is very real. That almost no parent takes the issue of psychiatric diagnosis lightly or rushes to 'drug' his or her child; and that responsible child psychiatrists don't, either. And that many children's lives are essentially saved by medication, particularly when it's combined with evidence-based forms of therapy."

How could she have been so convinced otherwise? Half the book is rueful legwork devoted to answering that question.

Ms. Warner points out that she was hardly alone in her previous assumptions: it is accepted wisdom in some circles, including, oddly, liberal-left "moms" and right-wing radio audiences, that the milder variants of attention deficit disorder, bipolar disorder and autism are just different ways of saying "normal, but not good enough."

Both groups share a disdain of parents who buy into those diagnoses, a horror of the medications used to treat them and a deep nostalgia for the simpler childhoods of past eras, when the child in question would definitely have been left alone.

Ms. Warner is sympathetic: "Believing that our toxic world is either producing symptoms in children or classifying them as abnormal when they don't conform is seductive. After all, there is so much wrong with the lives of children today."

She concedes that all the pressures to achieve socially, intellectually and financially can make a toxic brew. "We have to do something about our current social environment," she writes, "because it's creating some pretty big problems."

But she remains immutable on one point: the myth of the overmedicated child is just that — an allegory but not a reality.

Ms. Warner reported out the spectrum of pediatric psychiatric disorders with dozens of interviews. Most of the stories are variations on a theme: well-educated, sophisticated parents, unwilling, at first, to recognize a sick and miserable child who needs professional help.

Once help is finally sought, it is often quite difficult to obtain: there are few child psychiatrists in this country (about 7,000, by most estimates), fewer still good ones, and the usual plethora of dubious alternatives to orthodox medical care. Finally, after a reasonable facsimile of care is obtained, the child is usually better, but nowhere near perfect. "We don't know if he will have an independent life or will be institutionalized for life" is a typical conclusion.

But the big picture is far brighter than its components. Ms. Warner argues that child psychiatry is actually one of the major public health success stories of our time. As one expert tells her, when it comes to mental health, "the horse is out of the barn by adulthood." Treating troubled children is more than symptom management for a calmer classroom: the medications seem actually to change the structure of the brain, helping it develop in what all evidence indicates is the right direction. More children in treatment should spell the beginnings of a healthier adult world.

By her last section, Ms. Warner has worked herself up into something of a lather as she argues passionately for health care reform to ease access to treatment, for more good doctors who understand medications, for better drug research and far tighter reins on the pharmaceutical industry. Much of this has been stated somewhat more expertly and elegantly elsewhere.

But then again, we are all inured to expert voices preaching on these topics. Those who disagree stopped listening long ago, and Ms. Warner's earnest, wide-eyed exhortations will not bring them around. But for the choir, her version of the sermon will make a pleasant change.